Chiropractic is a health care profession that focuses on the relationship between the body's structure—mainly the spine—and its functioning. Although practitioners may use a variety of treatment approaches, they primarily perform adjustments (manipulations) to the spine or other parts of the body with the goal of correcting alignment problems, alleviating pain, improving function, and supporting the body's natural ability to heal itself.

Side effects from spinal manipulation can include temporary headaches, tiredness, or discomfort in the parts of the body that were treated. There have been rare reports of serious complications such as stroke, but whether spinal manipulation actually causes these complications is unclear. Safety remains an important focus of ongoing research.

Tell all your health care providers about any complementary health approaches you use. Give them a full picture of what you do to manage your health. This will help ensure coordinated and safe care.

Overview and History

The term “chiropractic” combines the Greek words cheir (hand) and praxis (practice) to describe a treatment done by hand. Hands-on therapy—especially adjustment of the spine—is central to chiropractic care. Chiropractic is based on the notion that the relationship between the body’s structure (primarily that of the spine) and its function (as coordinated by the nervous system) affects health.

Spinal adjustment/manipulation is a core treatment in chiropractic care, but it is not synonymous with chiropractic. Chiropractors commonly use other treatments in addition to spinal manipulation, and other health care providers (e.g., physical therapists or some osteopathic physicians) may use spinal manipulation.

Use in the United States

In the United States, chiropractic is often considered a complementary health approach. According to the 2007 National Health Interview Survey (NHIS), which included a comprehensive survey of the use of complementary health approaches by Americans, about 8 percent of adults (more than 18 million) and nearly 3 percent of children (more than 2 million) had received chiropractic or osteopathic manipulationA type of manipulation practiced by osteopathic physicians. It is combined with physical therapy and instruction in proper posture. in the past 12 months. Additionally, an analysis of NHIS cost data found that adults in the United States spent approximately $11.9 billion out-of-pocket on visits to complementary health practitioners—$3.9 billion of which was spent on visits to practitioners for chiropractic or osteopathic manipulation.

Many people who seek chiropractic care have low-back pain. People also commonly seek chiropractic care for other kinds of musculoskeletal pain (e.g., neck, shoulder), headaches, and extremity (e.g., hand or foot) problems.

An analysis of the use of complementary health approaches for back pain, based on data from the 2002 NHIS, found that chiropractic was by far the most commonly used therapy. Among survey respondents who had used any of these therapies for their back pain, 74 percent (approximately 4 million Americans) had used chiropractic. Among those who had used chiropractic for back pain, 66 percent perceived “great benefit” from their treatments.

Treatment

During the initial visit, chiropractors typically take a health history and perform a physical examination, with a special emphasis on the spine. Other examinations or tests such as x-rays may also be performed. If chiropractic treatment is considered appropriate, a treatment plan will be developed.

During followup visits, practitioners may perform one or more of the many different types of adjustments and other manual therapies used in chiropractic care. Given mainly to the spine, a chiropractic adjustment involves using the hands or a device to apply a controlled, rapid force to a joint. The goal is to increase the range and quality of motion in the area being treated and to aid in restoring health. Joint mobilization is another type of manual therapy that may be used.

Chiropractors may combine the use of spinal adjustments and other manual therapies with several other treatments and approaches such as:

What the Science Says

Researchers have studied spinal manipulation for a number of conditions ranging from back, neck, and shoulder pain to asthma, carpal tunnel syndrome, fibromyalgia, and headaches. Much of the research has focused on low-back pain, and has shown that spinal manipulation appears to benefit some people with this condition. (For more information, see the Spinal Manipulation for Low-Back Pain fact sheet.)

A 2010 review of scientific evidence on manual therapies for a range of conditions concluded that spinal manipulation/mobilization may be helpful for several conditions in addition to back pain, including migraine and cervicogenic (neck-related) headaches, neck pain, upper- and lower-extremity joint conditions, and whiplash-associated disorders. The review also identified a number of conditions for which spinal manipulation/mobilization appears not to be helpful (including asthma, hypertension, and menstrual pain) or the evidence is inconclusive (e.g., fibromyalgia, mid-back pain, premenstrual syndrome, sciatica, and temporomandibular joint disorders).

Safety

Side effects from spinal manipulation can include temporary headaches, tiredness, or discomfort in the parts of the body that were treated.

There have been rare reports of serious complications such as stroke, cauda equina syndrome (a condition involving pinched nerves in the lower part of the spinal canal), and worsening of herniated discs, although cause and effect are unclear.

Safety remains an important focus of ongoing research:

A 2007 study of treatment outcomes for 19,722 chiropractic patients in the United Kingdom concluded that minor side effects (such as temporary soreness) after cervical spine manipulation were relatively common, but that the risk of a serious adverse event was “low to very low” immediately or up to 7 days after treatment.

A 2009 study that drew on 9 years of hospitalization records for the population of Ontario, Canada analyzed 818 cases of vertebrobasilar artery (VBA) stroke (involving the arteries that supply blood to the back of the brain). The study found an association between visits to a health care practitioner and subsequent VBA stroke, but there was no evidence that visiting a chiropractor put people at greater risk than visiting a primary care physician. The researchers attributed the association between health care visits and VBA stroke to the likelihood that people with VBA dissection (torn arteries) seek care for related headache and neck pain before their stroke.

Practitioners: Education and Licensure

Chiropractic colleges accredited by the Council on Chiropractic Education (CCE) offer Doctor of Chiropractic (D.C.) degree programs. (CCE is the agency certified by the U.S. Department of Education to accredit chiropractic colleges in the United States.) Admission to a chiropractic college requires a minimum of 90 semester hour credits of undergraduate study, mostly in the sciences.

Chiropractic training is a 4-year academic program that includes both classroom work and direct experience caring for patients. Coursework typically includes instruction in the biomedical sciences, as well as in public health and research methods. Some chiropractors pursue a 2- to 3-year residency for training in specialized fields.

Tell all of your health care providers about any complementary health approaches you use. Give them a full picture of what you do to manage your health. This will help ensure coordinated and safe care. For tips about talking with your health care providers about complementary health approaches, see NCCIH’s Time to Talk campaign.

NCCIH-Funded Research

NCCIH-supported research on chiropractic care includes projects that have focused on:

Spinal manipulation for back pain, neck pain, and headache, as well as for other health conditions such as temporomandibular disorders

Development of a curriculum to increase the understanding of evidence-informed practice in chiropractic educational institutions

Influence of patients’ satisfaction with care on their response to treatment, in a study that compared chiropractic and medical care in a group of back-pain patients.

NCCIH also funded establishment of a developmental center for research in chiropractic at the Palmer Center for Chiropractic Research. Investigators at Palmer and at other partnering institutions conduct basic and clinical research on chiropractic treatment approaches, how they might work, and diseases and conditions for which they may be most helpful.

The Council on Chiropractic Education. Standards for Doctor of Chiropractic Programs and Requirements for Institutional Status January, 2007. The Council on Chiropractic Education Web site. Accessed at www.cce-usa.org/Publications.html on November 23, 2009.

For More Information

NCCIH Clearinghouse

The NCCIH Clearinghouse provides information on NCCIH and complementary health approaches, including publications and searches of Federal databases of scientific and medical literature. The Clearinghouse does not provide medical advice, treatment recommendations, or referrals to practitioners.

NIH Clinical Research Trials and You

The National Institutes of Health (NIH) has created a Web site, NIH Clinical Research Trials and You, to help people learn about clinical trials, why they matter, and how to participate. The site includes questions and answers about clinical trials, guidance on how to find clinical trials through ClinicalTrials.gov and other resources, and stories about the personal experiences of clinical trial participants. Clinical trials are necessary to find better ways to prevent, diagnose, and treat diseases.

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NCCIH has provided this material for your information. It is not intended to substitute for the medical expertise and advice of your primary health care provider. We encourage you to discuss any decisions about treatment or care with your health care provider. The mention of any product, service, or therapy is not an endorsement by NCCIH.